择期手术的“周末效应”。

A 'weekend effect' in operative emergency general surgery.

机构信息

Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

出版信息

Am J Surg. 2020 Jul;220(1):237-239. doi: 10.1016/j.amjsurg.2019.11.024. Epub 2019 Nov 13.

DOI:10.1016/j.amjsurg.2019.11.024

PMID:31744597

Abstract

BACKGROUND

Evidence of a "weekend effect" is limited in emergency general surgery (EGS). We hypothesized that there are increased rates of complications, death, and failure-to-rescue (FTR) in patients undergoing weekend EGS operations.

METHODS

National Inpatient Sample (NIS) data, January 2014-September 2015 were used. Operative EGS patients were identified by ICD-9 procedure code and timing to operation. Complications were defined by ICD-9 code. We performed survey-weighted multivariable regression analyses.

RESULTS

Of 438,110 EGS patients, 103,450 underwent weekend operation. There was no association between weekend operation and FTR (OR 1.17; 95%CI 0.95-1.45) or complications (OR 1.04; 95%CI 0.97-1.13). There was a weekend effect on mortality (OR 1.22; 95%CI 1.02-1.46) and an interactive effect between weekend operation and teaching status on complications (teaching OR 1.22; 95%CI 1.15-1.29; interaction OR 1.13; 95%CI 1.03-1.25).

CONCLUSIONS

There is evidence for a "weekend effect" on mortality, but not complications or FTR, in this cohort.

摘要

背景

在急诊普通外科（EGS）中，“周末效应”的证据有限。我们假设在接受周末 EGS 手术的患者中，并发症、死亡和救援失败（FTR）的发生率增加。

方法

使用国家住院患者样本（NIS）数据，时间为 2014 年 1 月至 2015 年 9 月。通过 ICD-9 手术代码和手术时间识别手术 EGS 患者。并发症通过 ICD-9 代码定义。我们进行了调查加权多变量回归分析。

结果

在 438,110 名 EGS 患者中，有 103,450 名患者接受了周末手术。周末手术与 FTR（OR 1.17；95%CI 0.95-1.45）或并发症（OR 1.04；95%CI 0.97-1.13）之间没有关联。周末手术与死亡率之间存在“周末效应”（OR 1.22；95%CI 1.02-1.46），并且周末手术和教学状态之间存在并发症的交互效应（教学 OR 1.22；95%CI 1.15-1.29；交互 OR 1.13；95%CI 1.03-1.25）。